Congressman urges feds to investigate Medicare fraud in Houston

Louisiana lawmaker cites Chronicle report on abuse

By Jacquee Petchel

Updated 9:41 pm, Thursday, March 8, 2012

The chairman of a powerful congressional oversight committee has called for investigations by three federal agencies into wanton Medicare fraud in the Houston region in which ambulance companies, mental health clinics and home health care agencies have cheated taxpayers out of tens of millions of dollars.

Citing an investigation last year by the Houston Chronicle, U.S. Rep. Charles Boustany Jr., R-La., said repeated testimony before a House Ways and Means subcommittee in early 2011 documented concerns about Medicare billing and yet, "Nearly a year later, recent reports out of Texas suggest ... providers continue to operate with impunity."

"The cases detailed in the Houston Chronicle are troubling if not surprising," Boustany wrote in a letter to Attorney General Eric Holder, Health and Human Services Secretary Kathleen Sebelius and Marilyn B. Tavenner, the acting director of the Centers for Medicare and Medicaid Services (CMS). Boustany is chairman of the House Ways and Means Subcommittee on Oversight.

Wants report by 21st

"When these people rip off Medicare, they are not just committing fraud, they are stealing money from seniors and the sick and it reduces the precious amount of money we have for those patients," said U.S. Rep. Kevin Brady, R-The Woodlands, who has been pushing for such an inquiry. "It's just one of the worst kinds of fraud. ... All this should be preventable."

The offices of Sebelius, Holder and Tavenner did not respond or could not be reached for comment.

The Chronicle's investigation in October documented hundreds of millions of Medicare dollars paid to private ambulance companies, many of which did not qualify for federal dollars. It further exposed the transporting of the mentally ill and poor from private homes and assisted living facilities to local mental health clinics - which also collected millions and yet require no license to operate in Texas.

Home health care agencies also reaped the spoils, the newspaper found, making $1.25 billion in the Houston area over a four-year period.

Boustany has asked Holder and Sebelius to investigate the specific Houston allegations. He's also requested a detailed account by March 21 of the number of Medicare fraud cases they have opened and - more specifically - the number of successful criminal convictions by the U.S. Attorney's Office.

"Other findings suggested kickbacks and other Medicare fraud by private ambulance services, mental health clinics, home health agencies and other Medicare providers throughout the Houston region," Boustany wrote in his letter Wednesday.

Of CMS, the congressman demanded an accounting of suspected overpayments in the Houston area over the last five years, as well as the amount of money from fraudulent practices that has been recovered.

'Rampant criminality'

Brady, along with Harris County District Attorney Pat Lykos and U.S. Rep. Gene Green, D-Houston, told the Chronicle they have tried since 2009 to get the attention of CMS - particularly because of the dollars paid to ambulance companies.

"I am delighted. We have been trying since 2009 to get the attention of federal authorities and most especially CMS, and they didn't even give me the courtesy of responding," Lykos said Thursday. "We're talking about millions of dollars, and it's unconscionable. They're stealing from people truly in need, robbing the taxpayers, and it's rampant criminality."

Between 2005 and 2010, Medicare records obtained by the Chronicle showed at least $488 million was paid to non-emergency ambulances in the Houston area. In 2009, taxpayers shelled out more than $60 million for ambulance bills, while New York City paid just $7 million.

"We want answers ... how it happened and how to stop it," Brady said Thursday. "I am pleased the congressman has requested more information and more answers from the government on this fraud, and I've been working with him to escalate the push."

Some recent successes

Since last year, U.S. prosecutors have successfully pressed several Medicare cases. In February, Mohammad Khan, an administrator for Riverside General Hospital, pleaded guilty for his role in a $116 million scheme that paid kickbacks to patient recruiters and personal care home owners in exchange for directing residents to the hospital's mental health clinics.

In November, Julian Vence Kimble of Houston pleaded guilty to master­minding an $8 million Medicare fraud scheme in which he used four private ambulance companies to ferry fake patients to mental health clinics.